MEDICARE: MS. JENNIFER ANNE KRONK TERRY LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	180-009978	IL

General Provider Information

NPI Number	:	1437729753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANNE KRONK TERRY LCPC

Provider Business Mailing Address
First Line	:	3045 W SUNNYSIDE AVE # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3846
Country	:	US
Telephone Number	:	312-925-7029
Fax Number	:

Provider Business Practice Location Address
First Line	:	3045 W SUNNYSIDE AVE # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3846
Country	:	US
Telephone Number	:	312-925-7029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	04/17/2023

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